Utilization Review Coordinator/Care Manager - Behavioral Health - Days

Utilization Review Coordinator- Behavioral Health - Days

Position Highlights:

• Position: Utilization Review Coordinator- Behavioral Health

• Hourly Pay Range: $35.16 - $54.50. The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

• Location: Deerfield, IL

• Full Time/Part Time: Full time- 40 hours

• Hours: Monday-Friday, 8am - 4:30pm

• Required Travel: yes to Evanston, IL

Job Profile Summary

Under supervision, the Utilization Review Coordinator guides the utilization management for behavioral health admissions, which involves pre-certification and concurrent reviews. Accumulates, analyzes, and documents timely clinical information to insurance payers to justify the admission or continued stay. High degree of collaboration with physicians, clinical therapists, and other patient care staff. Ensures quality of care is delivered at the appropriate level of care. Provides comprehensive orientation and ongoing education to direct care staff on topics and changes in utilization management. All duties are performed as delineated by licensure and/or experience.

What you will do:

• Pursues pre-authorization and concurrent review authorizations for appropriate level of care on a timely basis.

• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of patients served. This includes knowledge of the physical and psychological needs of patients served and the ability to respond appropriately to those needs.

• Serves as an advocate for assigned patients.

• Monitors admissions to assure accurate precertification to Inpatient, PHP, IOP, and other treatment requiring authorization.

• Reflects on patient's health plan benefits, taking into consideration the current episode of care as well as prior treatment and anticipated future clinical care.

What you will need:

Education:

• Master's Degree in a healthcare related field or a Registered Nurse

Certification:

• Current state licensure such as LCPC (Licensed Clinical Professional Counselor), LCSW (Licensed Clinical Social Worker), LPC (Licensed Professional Counselor) or LSW(Licensed Social Worker)

• Current state of Illinois Registered Nurse licensure, if RN

Experience:

• Minimum two years of clinically orientated experience in a behavioral health setting

• Minimum one year of previous utilization review experience

Unique or Preferred Skills:

• Knowledge of the DSM IVR (Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria

• Familiarity with continuum of care and assessment, intervention skills, managed care, Medicare, Medicaid, and other third-party reimbursement

• Knowledge of HIPPA and laws surrounding privacy

• Substantial knowledge base on insurance plans such as Commercial, Managed Care and capitated plans, Medicare, Medicaid and Workers Compensation preferred.

Benefits (For full time or part time positions):

• Eligibility for our Annual Incentive Plan, which offers the potential to earn a certain percentage amount of your base salary based on organizational performance. (For AIP eligible positions)

• Premium pay for eligible employees

• Career Pathways to Promote Professional Growth and Development

• Various Medical, Dental, Pet and Vision options

• Tuition Reimbursement

• Free Parking

• Wellness Program Savings Plan

• Health Savings Account Options

• Retirement Options with Company Match

• Paid Time Off and Holiday Pay

• Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.